Self-Reported Factors Affecting Family Physicians’ Scope of Practice

Background and Objectives: Robust evidence has shown that comprehensiveness lowers health care costs and physician burnout while improving quality. However, data suggest that scope of practice of family physicians has been decreasing. Our objective was to explore self-reported reasons for not providing inpatient care or deliveries by practice type.Methods: We used data from the American Board of Family Medicine 2016–2024 National Graduate Survey and 2017–2024 Continuing Certification Questionnaire. Both surveys had a common question on type of principal practice site and asked about delivering babies and providing adult inpatient care. Those who did not provide those services were asked follow-up questions. We analyzed reasons for not providing deliveries or inpatient care by practice type.Results: Our sample included 13,653 early career and 44,908 mid- to late-career family physicians. Early-career physicians were more likely to deliver babies and provide inpatient care than mid- to late-career physicians. Among those interested but not providing, lifestyle considerations were the first or second most common reason given for not delivering babies or providing inpatient care. Academic practice had the lowest rates of unavailability as a reason for not providing care, but hospital/health systems had similar rates to many other types of practices.Conclusions: The reasons for not delivering babies or providing inpatient care are multifactorial. Our findings suggest that many physicians are interested in providing inpatient care and delivering babies, but are limited by both their employers and personal interests or constraints.